创业与商业arstechnica.com
高盛质疑：治愈病人是否是可持续的商业模式
Goldman Sachs questions whether curing patients is a sustainable business model
2018 — 2021，它一次次回到首页
黑点是上首页（≥ 50 分）的那次投稿，空心点是没冲上去的投稿，点越大分数越高。
导读
这篇 Ars Technica 报道介绍高盛分析师提出的一个争议性观点：从制药商业模式看，能长期控制症状、让患者持续用药的疗法，可能比一次性治愈疾病更“可持续”。文章以丙肝等药物为例，讨论治愈型疗法对药企收入结构的冲击。
为什么经久不衰：它把医药创新最核心的激励矛盾摆上台面：救命的“治愈”与可持续的利润如何兼容，此后每次高价药和医疗支付争议都会回到这个问题。
HN 评论精选
以吉利德丙肝药为例反驳，认为治愈同样能带来巨额利润并形成竞争压力。
当然可持续。吉利德通过治愈丙肝赚了1000亿美元，而种子研究投资可能远低于10亿。只要这种巨大差价和盈利潜力存在，制药公司就会面临竞争压力去做出更好的疗法，尽管从集体角度看，靠病症“挤奶”可能赚数万亿。这有点像某种“公地悲剧”：单个公司试图抢占更多市场，反而通过找到治愈方法毁掉所有人的利润；看，这就是自由市场的魔力。它们只有通过签订不竞争协议、集体同意不创新才能逃脱，而这是一个需要大量证据的重大主张。
cornholio查看英文原文
Sure it is. Gilead made 100 billion dollars curring Hep-C with seed research investments that were probably much less than 1 billion. So as long as this strong differential and potential for profit exists, drug companies feel competitive pressure to produce better treatments, irrespective of the fact that "milking" the pathology would yield them trillions collectively. It's effectively a "tragedy of the commons" of sorts: a single company trying to capture more of the market ruins profits for everybody else by finding a cure; behold, the magic of the free market. They can only escape it by entering non-compete agreements and collectively agreeing not to inovate, a substantial claim that requires substantial evidence.
患者视角：终身治疗耗材比一次性治愈更有利可图，治愈研究融资困难。
作为1型糖尿病患者，我深有同感。卖给我胰岛素、检测用品、泵等终身需要的东西，显然比找到治愈方法更赚钱——治愈也许只能卖我一次，或者一年一次。我知道有人在努力寻找治愈方法，但也知道他们很难获得资金。
friedegg查看英文原文
As a type 1 diabetic, I feel this. It sure seems like there's a lot more money to be made from me selling insulin, testing supplies, pumps, etc, that I'll need to use for life (29 years and counting) than in finding a cure, which perhaps they can sell me once, or maybe yearly. I know there are people working hard to find a cure, but I also know that they struggle with getting funding.
认为追求治愈才是正确商业策略，一旦治愈出现，长期治疗模式会失去市场。
这（不断扩展治疗组合）对公司和全社会都是正确做法。事实上这太明显了，奇怪的是居然需要一份报告来说明。即使只看商业面，只开发慢性治疗而不开发治愈，也只有在看不到治愈希望时才成立。一旦出现治愈，卖无尽治疗的人会亏钱（几乎赚不到钱且沉没成本无法收回），而卖治愈的人会赚走几乎所有的钱。况且公司管理者也有身体，也有家人朋友，最终他们也会想要治愈。
dwheeler查看英文原文
> It also suggests that companies be innovative and constantly expanding their portfolio of treatments. This is the right approach, both for a company and for society. In fact, it's so obvious, that it's weird anyone thought they needed a report to say it. Even if you only look at the business side (instead of the human side), only developing chronic treatments instead of cures only makes sense if there's no cure on the horizon. Once there is a cure, the people who sell endless treatments will lose money (they'll make basically nothing & they'll have a lot of sunk cost they can't recoup), while those who sell the cure will make practically all the money. Besides, the people who run companies also have bodies (who knew?)), as well as family & friends with bodies. Eventually they'll want those cures too.
用销售数据说明丙肝治愈药是商业上的巨大成功，文章举例不当。
这文章有点烂。Sovaldi 这个例子很糟糕。在 Sovaldi 之前，最畅销药是立普妥，然后是修美乐，峰值全球年销约100亿美元（峰值在上市十多年后）。想想资金时间价值：研发投入在10-15年后才达到收入峰值。Sovaldi 第一个完整年就卖了120亿。那一年吉利德所有丙肝药加起来卖了多少？190亿。这打破了所有纪录。6年后它只带来40亿。注意在这个行业峰值超过10亿就算成功。丙肝治愈药无论从哪方面看都是绝对的重磅成功。
refurb查看英文原文
Kind of a crappy article. The example of Sovaldi is a terrible one. Prior to Sovaldi, the best selling drugs were Lipitor, then Humira which made ~$10B per year at peak worldwide (peak being a decade or more post launch). Think about the time value of money when your R&D investment hit peak revenue 10-15 years later. Sovaldi made $12B in its first year full year. What did Gilead make across all its hepatitis C drugs that year? $19B. That blew all records out of the water. And 6 years later it’s pulling in $4B. Note this is in an industry where exceeding $1B at peak is a success. The hepatitis C cures are an absolute blockbuster by any stretch of the imagination. https://www.evaluate.com/vantage/articles/data-insights/hep-c-might-be-fading-it-still-broke-records
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